Healthcare Provider Details

I. General information

NPI: 1972885523
Provider Name (Legal Business Name): JESSICA ROSE FRAZIER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA ROSE HARRIS CRNA

II. Dates (important events)

Enumeration Date: 09/09/2011
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12911 W 40TH AVE
WHEAT RIDGE CO
80401
US

IV. Provider business mailing address

PO BOX 173656
DENVER CO
80217-3656
US

V. Phone/Fax

Practice location:
  • Phone: 303-425-4500
  • Fax:
Mailing address:
  • Phone: 303-425-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberNA4116
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPN.0997124-CRNA
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: